Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts.
Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts.
JAMA Netw Open. 2024 Jul 1;7(7):e2421740. doi: 10.1001/jamanetworkopen.2024.21740.
Serious injection-related infections (SIRIs) cause significant morbidity and mortality. Medication for opioid use disorder (MOUD) improves outcomes but is underused. Understanding MOUD treatment after SIRIs could inform interventions to close this gap.
To examine rehospitalization, death rates, and MOUD receipt for individuals with SIRIs and to assess characteristics associated with MOUD receipt.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used the Massachusetts Public Health Data Warehouse, which included all individuals with a claim in the All-Payer Claims Database and is linked to individual-level data from multiple government agencies, to assess individuals aged 18 to 64 years with opioid use disorder and hospitalization for endocarditis, osteomyelitis, epidural abscess, septic arthritis, or bloodstream infection (ie, SIRI) between July 1, 2014, and December 31, 2019. Data analysis was performed from November 2021 to May 2023.
Demographic and clinical factors potentially associated with posthospitalization MOUD receipt.
The main outcome was MOUD receipt measured weekly in the 12 months after hospitalization. We used zero-inflated negative binomial regression to examine characteristics associated with any MOUD receipt and rates of treatment in the 12 months after hospitalization. Secondary outcomes were receipt of any buprenorphine formulation, methadone, and extended-release naltrexone examined individually.
Among 8769 individuals (mean [SD] age, 43.2 [12.0] years; 5066 [57.8%] male) who survived a SIRI hospitalization, 4305 (49.1%) received MOUD, 5919 (67.5%) were rehospitalized, and 973 (11.1%) died within 12 months. Of those treated with MOUD in the 12 months after hospitalization, the mean (SD) number of MOUD initiations during follow-up was 3.0 (1.7), with 956 of 4305 individuals (22.2%) receiving treatment at least 80% of the time. MOUD treatment after SIRI hospitalization was significantly associated with MOUD in the prior 6 months (buprenorphine: adjusted odds ratio [AOR], 16.51; 95% CI, 13.81-19.74; methadone: AOR, 28.46; 95% CI, 22.41-36.14; or naltrexone: AOR, 2.05; 95% CI, 1.56-2.69). Prior buprenorphine (incident rate ratio [IRR], 1.17; 95% CI, 1.11-1.24) or methadone (IRR, 1.89; 95% CI, 1.79-2.01) use was associated with higher treatment rates after hospitalization, and prior naltrexone use (IRR, 0.86; 95% CI, 0.77-0.95) was associated with lower rates.
This study found that in the year after a SIRI hospitalization in Massachusetts, mortality and rehospitalization were common, and only half of patients received MOUD. Treatment with MOUD before a SIRI was associated with posthospitalization MOUD initiation and time receiving MOUD. Efforts are needed to initiate MOUD treatment during SIRI hospitalizations and subsequently retain patients in treatment.
严重的注射相关感染（SIRIs）会导致严重的发病率和死亡率。阿片类药物使用障碍（MOUD）的药物治疗可改善预后，但使用不足。了解 SIRI 后 MOUD 的治疗情况可以为缩小这一差距提供信息。
检查 SIRI 患者的再住院率、死亡率和 MOUD 接受情况，并评估与 MOUD 接受相关的特征。
设计、设置和参与者：这项回顾性队列研究使用了马萨诸塞州公共卫生数据仓库，该数据库包含了所有在全支付者索赔数据库中有索赔的个人的数据，并且与来自多个政府机构的个人水平数据相链接，以评估年龄在 18 至 64 岁之间的患有阿片类药物使用障碍并因心内膜炎、骨髓炎、硬膜外脓肿、化脓性关节炎或血流感染（即 SIRI）住院的个人，时间范围为 2014 年 7 月 1 日至 2019 年 12 月 31 日。数据分析于 2021 年 11 月至 2023 年 5 月进行。
可能与住院后 MOUD 接受情况相关的人口统计学和临床因素。
主要结果是在住院后 12 个月内每周测量 MOUD 的接受情况。我们使用零膨胀负二项回归来检查与任何 MOUD 接受情况相关的特征以及住院后 12 个月内的治疗率。次要结果是单独检查任何丁丙诺啡制剂、美沙酮和纳曲酮的接受情况。
在 8769 名幸存的 SIRI 住院患者中（平均[标准差]年龄，43.2[12.0]岁；5066[57.8%]为男性），4305 名（49.1%）接受了 MOUD，5919 名（67.5%）再次住院，973 名（11.1%）在 12 个月内死亡。在住院后 12 个月内接受 MOUD 治疗的患者中，随访期间 MOUD 起始的平均（标准差）数量为 3.0（1.7），其中 4305 名患者中有 956 名（22.2%）至少接受了 80%的治疗。SIRI 住院后 MOUD 治疗与之前 6 个月的 MOUD 治疗显著相关（丁丙诺啡：调整后的优势比 [AOR]，16.51；95%置信区间 [CI]，13.81-19.74；美沙酮：AOR，28.46；95%CI，22.41-36.14；或纳曲酮：AOR，2.05；95%CI，1.56-2.69）。之前使用丁丙诺啡（发生率比 [IRR]，1.17；95%CI，1.11-1.24）或美沙酮（IRR，1.89；95%CI，1.79-2.01）与住院后更高的治疗率相关，而之前使用纳曲酮（IRR，0.86；95%CI，0.77-0.95）与较低的治疗率相关。
这项研究发现，在马萨诸塞州 SIRI 住院后的一年中，死亡率和再次住院率很高，只有一半的患者接受了 MOUD。在 SIRI 之前使用 MOUD 与住院后 MOUD 的启动和接受 MOUD 的时间相关。需要努力在 SIRI 住院期间开始 MOUD 治疗，并随后维持患者的治疗。
